[P1-116] Two Cases of Anti-MOG Antibody Positive ADEM Associated with Chlamydophila Pneumoniae
[Introduction] The relationship between Chlamydia and demyelinating diseases has been in debate. The anti-myelin oligodendrocyte glycoprotein (MOG) antibody could be produced by molecular mimicry in patients with Chlamydia infection.
[Case 1]A 6-year-old boy presented vomiting, fever and headache after vaccinations, and admitted to Seikeikai Hospital. Although the brain magnetic resonance imaging (MRI) showed no abnormalities, he was suspected to have acute disseminated encephalomyelitis induced by vaccinations. He was managed with intravenous high-dose methylprednisolone (IVMP) and his symptoms were cured. However, soon after discontinuation of prednisolone, his symptoms aggravated and novel brain lesions were seen with MRI. The symptoms were relieved after reinitiation of prednisolone, however prednisolone at less than 10 mg daily could not prevent minor exacerbations. Therefore, intravenous immunoglobulin was prescribed. High titers of anti-MOG antibody remained for more than two years.
[Case 2] A 3-year-old boy developed high fever and was lying exhausted. Even after alleviation of fever, he could not walk; therefore, he was admitted to Seikeikai Hospital. His consciousness was not disturbed but he showed cerebellar and pyramydal signs. Brain MRI disclosed T2 lesions in the white matter. He was managed with IVMP and was discharged without sequelae. Anti-MOG antibody was elevated to1:32,768. Retrospective analysis of pathogens revealed Chlamydophila pneumoniae IgM antibodies in these two patients.
[Discussion] It is important to enlighten the relation between Chlamydia infection and inflammatory demyelinating disease. Although precise pathomechanisms between the Chlamydia infection, the anti-MOG antibody and the development of demyelinating diseases are currently unclear, further research will be needed.
[Case 1]A 6-year-old boy presented vomiting, fever and headache after vaccinations, and admitted to Seikeikai Hospital. Although the brain magnetic resonance imaging (MRI) showed no abnormalities, he was suspected to have acute disseminated encephalomyelitis induced by vaccinations. He was managed with intravenous high-dose methylprednisolone (IVMP) and his symptoms were cured. However, soon after discontinuation of prednisolone, his symptoms aggravated and novel brain lesions were seen with MRI. The symptoms were relieved after reinitiation of prednisolone, however prednisolone at less than 10 mg daily could not prevent minor exacerbations. Therefore, intravenous immunoglobulin was prescribed. High titers of anti-MOG antibody remained for more than two years.
[Case 2] A 3-year-old boy developed high fever and was lying exhausted. Even after alleviation of fever, he could not walk; therefore, he was admitted to Seikeikai Hospital. His consciousness was not disturbed but he showed cerebellar and pyramydal signs. Brain MRI disclosed T2 lesions in the white matter. He was managed with IVMP and was discharged without sequelae. Anti-MOG antibody was elevated to1:32,768. Retrospective analysis of pathogens revealed Chlamydophila pneumoniae IgM antibodies in these two patients.
[Discussion] It is important to enlighten the relation between Chlamydia infection and inflammatory demyelinating disease. Although precise pathomechanisms between the Chlamydia infection, the anti-MOG antibody and the development of demyelinating diseases are currently unclear, further research will be needed.